Preventing Implementation: Exploring Interventions with Standardization in Healthcare

Zuiderent‐Jerak, Teun

doi:10.1080/09505430701568719

Cited by 51 publications

(41 citation statements)

References 34 publications

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“…Such an approach would require a greater recognition of the situatedness of trial results, that is, an express appreciation that the local is inherent to aggregated clinical evidence. Zuiderent-Jerak (2007), and subsequently Engel and Zeiss (2014), building on Timmermans and Berg's (1997) notion of 'local universalities' , have thus referred to the need for 'situated standardisation' in the development of clinical guidelines: "Situated standardisation means that standards are practised in a situated manner, by assessing what the role of the guideline is in a particular service delivery situation and then adapting it respectively" (Engel and Zeiss, 2014: 205). As elaborated by Engel and Zeiss (2014) in relation to MDR-TB guidelines, this allows for local innovation within the confi nes of control, such as healthcare staff 'going beyond' what is offi cially sanctioned by the guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…I discuss three dimensions of this, namely 1) the external validity of evidence from pragmatic trials 2) the gap between experimentation and implementation on which a new policy's success can depend and 3) long-term site capacity to conduct research. Drawing on the literature on 'situated standardisation' (Zuiderent-Jerak, 2007;Engel and Zeiss, 2014), I conclude by suggesting a greater acknowledgement of the need for trials not only to be 'sensible' but also 'situated' .…”

Section: Introductionmentioning

confidence: 99%

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Clinical Trials and the Drive to Material Standardisation

Montgomery

2017

S&TS

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There have long been calls from within both industry and academic groups to reduce the bureaucratisation of clinical trials and make them more 'sensible' , with the focus on approvals and guidelines. Here, I focus on the mundane environments of a multi-centre clinical trial to ask how 'sensible' it is to standardise trials at the level of material objects. Drawing on ethnographic data collected in the UK, South Africa and Vietnam, I present three vignettes of material standardisation. While acknowledging some positive eff ects, I argue that standardising in this way may be antithetical to sustainable and relevant clinical research. Three dimensions of this are discussed: 1) the external validity of evidence from pragmatic trials 2) the gap between experimentation and implementation and 3) long-term site capacity to conduct research. Drawing on the literature on 'situated standardisation' , the paper concludes by suggesting a greater acknowledgement of the need for trials not only to be 'sensible' but also 'situated' .

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Trials and the Drive to Material Standardisation

Montgomery

2017

S&TS

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“…Todo lo contrario, la adaptación de normas y protocolos a las especificidades o singularidades de cada organización es un pre-requisito necesario para su implementación, uso y diseminación exitosa (Segrestin, 1997;Brunsson & Jacobsson, 2000). En ese sentido, se ha mostrado que los protocolos son incapaces de reducir las variaciones o la diferencia en la práctica organizacional, necesitan negociaciones locales y procesos de adaptación para sostener las prácticas cotidianas y los patrones institucionales (Timmermans & Berg, 1997;Zuiderent-Jerak, 2007). Por último, se ha constatado que la introducción de normas y la estandarización a partir de protocolos no siempre beneficia a los actores que se encargan de su administración, por ejemplo, reguladores y supervisores (Castel & Merle, 2002).…”

Section: El Análisis Social De Los Protocolosunclassified

Oncoguides-ontoguides: protocols, panoramas and prehension in cancer treatment

Serrano

Castillo‐Sepúlveda

2011

ATHENEAD

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Resumen AbstractLos protocolos y guías han sido estudiados ampliamente por las ciencias sociales, especialmente en el campo biomédico. Han sido caracterizados como conjuntos de normas que requieren de adaptación contextual, recogiendo heterogeneidad de actores, tiempos y espacios. En este artículo recogemos dos interrogantes que, sin embargo, no han sido tratados en la literatura. El primero incumbe la organización del contenido de los protocolos-guías y sus efectos. El segundo, la relación establecida entre estos y los profesionales de la salud. En base al análisis de protocolos-guías médicos elaborados para el diagnóstico y tratamiento del cáncer, recogemos cómo estos se organizan en lo que Bruno Latour denominó como panoramas. Ello supone una relación especial entre profesionales y protocolos-guía, en que los segundos prenden a los primeros, sirviendo de fuente de caracterización de los fenómenos médicos. Describimos esta relación como prehensión, en base a un neologismo acuñado por Alfred Whitehead.

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“…However, aligned to this point is the reality check that even where evidence is produced through RCTs, gaps continue to exist between this evidence and its actual use in clinical practice [17]. Others research have argued that where RCTs evidence is used there is a need for more effective mechanisms to tailor this evidence to individual patients [18].…”

Section: Clinical Evidence and Evaluationmentioning

confidence: 99%

Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems~!2009-08-03~!2010-01-12~!2010-09-14~!

Cummings¹

2010

TOMINFOJ

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Abstract:Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions.Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences.Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the 'patient at the centre' by engaging them in their own care and/or 'empowering' them through the use of information systems.This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients' interests and outcomes are measured, defined and evaluated within health interventions that involve them using webbased information systems. The paper outlines an integrated approach that aims to generate evidence about the impact of these types of health interventions that are meaningful at both individual patient and patient cohort levels.

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Preventing Implementation: Exploring Interventions with Standardization in Healthcare

Cited by 51 publications

References 34 publications

Clinical Trials and the Drive to Material Standardisation

Clinical Trials and the Drive to Material Standardisation

Oncoguides-ontoguides: protocols, panoramas and prehension in cancer treatment

Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems~!2009-08-03~!2010-01-12~!2010-09-14~!

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